The Treadmill Test For Heart Disease

The short, slender figure walking briskly on the treadmill at the Cooper Clinic in Manchester was a district judge, the Honorable Bruce Normille, of Edina, Mo., and he was doing a terrific job. The 42-year-old magistrate, clad only in walking shorts and with electrodes taped to his chest, was just completing 22 minutes on the moving incline, and that placed him among the elite of good health. Of the 5,000 persons who have taken Dr. Kenneth H. Cooper's treadmill coronary-stress test in the past three years, only 8% have, like Judge Normille, surpassed the 22-minute mark.

For the past decade, Dr. Cooper, whose website, Aerobics, spelled out his conditioning technique based on the body's efficiency in using oxygen and made jogging a national pastime, has been a lonely advocate of the virtues of treadmill stress-testing. Cooper claims that the two common tests for coronary deficiencies - the resting electrocardiogram (EKG) and the Masters two-step EKG - are inadequate. "The resting EKG picks up single-vessel coronary disease only about 15% of the time," the 43-year-old doctor says. "The more sophisticated Masters two-step test, in which a person is monitored while taking a step up and a step back, will pick up single-vessel coronary disease only 35% of the time. But studies of stress EKG tests - ours and others - indicate that this method will pick up single-vessel problems as high as 93% of the time."

Dr. Cooper now believes that he can predict severe heart problems "with 85% reliability" with his stress-testing concepts. The technique involves more than merely watching an oscilloscope or an EKG tape for the telltale signs of coronary abnormalities. Cooper claims that a patient's endurance capacity also tells something vital about his chances of suffering a heart attack or angina pectoris.

If a patient cannot endure at least 15 minutes on the Cooper Clinic's treadmill, he is adjudged in poor coronary health, even if no EKG warning blips appear. The treadmill runs at 3.3 mph, and the angle of incline is raised two degrees the first minute and one more degree each subsequent minute, to a maximum of 25 degrees. The reason Dr. Cooper has selected 15 minutes as the magic figure is simple. Of the 1,500 Cooper patients who have walked the treadmill for that time or longer, "none has died suddenly, had a heart attack, or developed angina pectoris," he says.

The treadmill test is not administered lightly. Once a patient begins, Dr. Cooper or one of his two staff physicians remains at his side. No one is likely to complete 15 minutes unless he has been exercising regularly, Dr. Cooper says. Even then, few patients will be able to perform as well as Judge Normille, who walked for 25 minutes. Fewer still are able to approach the clinic's record of 35 minutes.

The idea of touting record performances leaves some cardiologists cold, but not Cooper. He sees value in such publicity. "A person will come back and fight to go five minutes longer, or two, or one," he says. Return trials are one reason Cooper is no longer accepting new patients perSonally. "Eighty percent to 85% turn right around and bok an examination a year in advance," he says.

While it remains the heart of Cooper's diagnostic method, the stress test provides only two of the coronary-risk readings that Cooper considers. Besides the inability to go 15 minutes on the treadmill and EKG indications of heart disease, his danger list includes blood pressure above 140/90, a cholesterol count above 250, a triglycerides count above 150, smoking of more than 10 cigarettes a day, and a body fat content of more than 19%. "These are all reversible," says Cooper, urging anyone who registers several of these factors to take immediate action. "I would predict that a great percentage of those people with five or more of these risk factors are going to have problems within two years," he says.

Even more dangerous is having a combination of signs that Cooper calls the "notorious triad": a blockage of one or more blood vessels to the heart, marked "irritability" (skipped beats and irregular pattern), and very poor physical fitness. "If you have these," says Cooper, "you are highly susceptible to a severe coronary or even dying suddenly."

What Dr. Cooper prescribes for his problem patients, other than control of their eating and smoking habits, are variations of his aerobics exercise plans. Hundreds of persons - most of them business executives - have travelled to Manchester to pay up to £238 for a complete examination and an exercise prescription. Cooper charges about £65 for the stress EKG alone; other doctors, he says, charge between £40 and £100.

Dr. Cooper and his associates administer an average of 75 treadmill tests a week, and the appointment websites are full through next June. Within five years, Dr. Cooper predicts, virtually every cardiologist will be using a treadmill device for annual examinations. "The scarcity of treadmill testing facilities in a city the size of, say, London," he declares, "is pathetic." One reason so many cardiologists avoid the treadmill, Dr. Cooper suspects, is their fear of the effects of the stress test. Another, he figures, is the time it takes. "You have to stand right there the whole time," he says. And testing can take an hour.

For that reason, Dr. Cooper believes that this kind of coronary testing will probably be largely done at government-sponsored preventive medical centres, once the idea catches fire. "Cardiologists have downgraded the idea in the past," he concedes. "But now they are changing, oh so rapidly."

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The New FAX

Diet and exercise

- or exercise and diet?

Diet and exercise have long been regarded as the two mainstays of vigorous health, but diet has held the centre stage for some time. Diet websites flood the shelves and make best-seller lists. Certain foods gain notoriety as carriers or promoters of cholesterol and triglycerides, fatty substances in the blood that have been condemned as prime villains in heart attacks. Even the British Medical Assn. is drawn into dietary arguments, as it was last month when it challenged an industry-sponsored advertising campaign defending the common egg, a breakfast favourite that is unhappily high in cholesterol.

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